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Last updated: Jun 23, 2022
4 min read

Is Wegovy covered by insurance?

 

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

If you’re looking for a prescription weight loss solution that may help you reach your healthy weight goals, Wegovy (semaglutide) may be an option. However, it may come with a hefty price tag, leaving you wondering—is Wegovy covered by insurance? Not always, but the good news is that there are ways to save money on Wegovy, even if your insurance doesn’t cover it. 

Here’s what you need to know about getting help paying for Wegovy, regardless of whether you have insurance to help cover the costs.

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What is Wegovy?

Wegovy (semaglutide) is a prescription weight loss medication approved by the Food and Drug Administration (FDA) for adults with obesity (BMI≥30) or overweight (BMI ≥27), who also have at least one weight-related medical condition, such as type 2 diabetes or high blood pressure (FDA, 2021)

This once-weekly injection mimicks the hormone glucagon-like peptide-1 (GLP-1), which targets areas of the brain that regulate appetite and food intake. One 68-week trial found that Wegovy users lost an average of 14.9% of their body weight throughout the trial (Wilding, 2021).

As with many weight loss medications, you should combine Wegovy usage with a healthy diet and exercise for best results. And to minimize side effects, it’s recommended to start with a weekly dosage of 0.25 mg of Wegovy and work up to 2.4 mg over 17 weeks (FDA, 2021). 

What are the side effects of Wegovy?

Just like most prescription drugs, Wegovy may cause side effects that range from mild to severe. In clinical trials, nausea, vomiting, and diarrhea were the most common side effects (Wilding, 2021). 

Other common side effects of Wegovy include (FDA, 2021):

  • Constipation
  • Abdominal pain
  • Headache
  • Fatigue
  • Dizziness
  • Bloating and gas
  • Indigestion
  • Acid reflux

Potentially serious side effects of Wegovy may include (FDA 2021):

  • Severe allergic reaction
  • Increased heart rate
  • Low blood sugar
  • Low blood pressure
  • Inflammation of the pancreas (pancreatitis)
  • Gallbladder problems
  • Kidney problems
  • Diabetic retinopathy

If you experience any of these serious side effects, contact your healthcare provider immediately. They may alter your medication dosage or change your care plan altogether to help reduce the severity of your side effects (FDA, 2021). 

Wegovy insurance coverage

Wegovy insurance coverage varies depending on your specific health plan. Many commercial and private insurers don’t cover the cost of weight loss medications. However, it’s important to review your plan’s drug list (also known as a drug formulary) or contact your health insurance provider to determine whether your plan covers the medication.

If your insurance company doesn’t cover Wegovy, you and your healthcare provider can write an appeal letter to request coverage. 

Do Medicaid or Medicare approve Wegovy?

Each state determines which prescription drugs they will include as part of their Medicaid program. As a result, drug coverage for Medicaid beneficiaries varies depending on the state in which you live.

Contact your state Medicaid agency to determine whether your state’s Medicaid program covers Wegovy. 

As for Medicare, weight loss medications like Wegovy are usually not covered. However, you need to check your specific plan’s prescription medication coverage to find out for sure.

Wegovy cost with insurance vs. Wegovy cost without insurance

The Wegovy cost without insurance fluctuates, but you can expect an average cash price of over $1,800 for one carton of four prefilled 0.25mg/0.5ml pens, which is a one-month supply. Once you’ve reached the maximum dosage after 17 weeks, Wegovy retails for an average price of around $1,500 for four prefilled 2.4mg/0.75ml pens (GoodRx, 2022).

Your out-of-pocket cost with insurance depends on your insurance coverage. It’s important to include your prescription copay and deductible when determining how much your supply of Wegovy with cost after insurance has covered their portion.

Regardless of your insurance plan, your provider may require prior authorization to receive coverage benefits. You may also need to try a less expensive weight loss medication before receiving approval for Wegovy. 

Are there ways to save money on Wegovy?

Unfortunately, there are no generic versions of Wegovy currently available. Although it may come at a higher price than other weight loss drugs, there are several ways to save money on your prescription Wegovy cost. 

Wegovy savings card 

With a Wegovy savings card, you can receive a 28-day supply of your prescription medication for as little as $25. However, certain eligibility requirements and restrictions apply. If your insurance doesn’t cover it or you pay cash for your prescription medications, you can save up to $500 per 28-day supply. If your commercial or private health insurance covers Wegovy, you can save up to $200 per 28-day supply (Wegovy.com, 2021). 

Prescription discount cards

Companies like GoodRx or SingleCare provide prescription discount cards for certain medications (GoodRx, 2022; SingleCare, 2022). Just type in your prescription drug name and location, and they will give you discounted prices based on the pharmacies in your area. You can also talk to your pharmacist about prescription discount cards they may offer at the pharmacy.

Compare pharmacy prices

Prescription drug prices can vary from pharmacy to pharmacy. To find the lowest price, call several local pharmacies and ask what their retail price is for Wegovy. If you plan to use your insurance, you may need to show the pharmacy your prescription and insurance card before they can provide a price. 

If you have insurance, but they don’t offer coverage for Wegovy, you can still compare pharmacy prices to find the best deal near you. Ask your pharmacist to run the cash price of Wegovy through the various pharmacy discount programs to find the lowest price.

Ozempic manufacturer assistance program

If you also have diabetes, you might qualify for the Novo Nordisk Patient Assistance Program (PAP). This program provides eligible patients with access to free diabetes medicine, which may include Ozempic (semaglutide). Ozempic injections deliver the same medication as Wegovy but in smaller doses (0.25, 0.5 mg, and 1.0 mg). 

Talk to your healthcare provider about whether Ozempic is an option for you. Your care team will help determine the best treatment options and help you apply to the Novo Nordisk PAP if you qualify.

Ultimately, finding out whether your insurance plan covers Wegovy and how much it’ll cost comes down to reaching out to your insurance provider directly. But, even if they don’t cover it, the tips above may help you save money on this medication.

References

  1. GoodRx. (2022). Wegovy prices, coupons & savings tips. Retrieved from https://www.goodrx.com/wegovy
  2. SingleCare. (2022). Wegovy coupons & prices. Retrieved from https://www.singlecare.com/prescription/wegovy
  3. U.S. Food and Drug Administration (FDA). (2021). Highlights of Prescribing Information Wegovy (semaglutide) injection. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/215256s000lbl.pdf 
  4. Wegovy.com. (2021). Wegovy coverage and savings. Retrieved from https://www.wegovy.com/coverage-and-savings/wegovy-savings-and-support.html 
  5. Wilding, J. P. H., Batterham, R. L., Calanna, S., et al. (2021). Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine, 384(11), 989–1002. doi:10.1056/NEJMoa2032183. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33567185